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3 1/2 month old slow growth, former EP- how serious is it?

Maybe this should have gone in the preemie section, but I wanted a little more general experience.

My daughter was born 5 weeks premature. She'll be four months on the 29th, 2 3/4 months corrected age. It has taken us a while (some of you probably remember me) of EP'ing and trying to get her to nurse but we are now 100% on the breast, other then her bottles to get her heart medication which are expressed breastmilk!!!!!! I had honestly wondered if we would ever get here, but we did!

Here's the problem. She is only gaining 1/3 of an ounce a day. Before, when she was fully on EBM with high-calorie formula added in, she still was only gaining 1/2 an ounce a day. So this is not a drastic change here. She has grown 4 inches since her birth. She's a little fussy, but I've had other babies who were good gainers who were just as fussy, and she's just more sensitive. Plus, she's hardly been put down since we were allowed to hold her, so she's used to that. She does have reflux which we're treating with Zantec.

The pediatrician is freaking and wants her on all formula, or at least rice cereal in the bottles because it's OBVIOUSLY a supply issue or that it takes SO much energy to breastfeed, or else a quality of my milk problem. LC's are certain it's not a supply issue because I can feel breasts softening, have good let down, and if I pump instead of feed (extremely rare these days!) I get 3.5-5 ozs. I don't let down for hte pump anymore, at least not as strongly as I do for her. I can feel it for her. After I feed her, I get about 1.5 ozs. They said that's normal since the breast is never empty. They do not feel I have a supply problem and neither do I, although I do get a bit nervous since I hardly ever pump anymore (too busy nursing!). They suggested starting solids at 4 months instead and adding in higher density foods (like avocado or sweet potato with olive oil) for growth instead of adding formula. That sounded good to me, but when we mentioned it to my ped was when we got the rice cereal in the bottle suggestion (which wouldn't work with giving her the heart meds anyways, it has to be a small amount she can drink quickly.) He wants me to do 10 minutes on each side then give her a bottle. I don't want to do that. He doesn't get the concept of on-demand breastfeeding, and I know from experience I can kiss what we have good bye if I listen to this advice. But even though the hospital LC's are on my side, including the NICU LC, I am still nervous about what we have chosen to do. OTOH, I don't want to give her formula either. I know a preemie with a heart condition is in even greater need of breastmilk then other babies and avoiding the risks of formula feeding then others.

The good points:
* She has 1-3 poopy diapers and over 8 wet diapers a day
* She's eating at least every 2 hours, except at night, where she will go 3-4 hours between feeds
* She is smiling, laughing, cooing, grabbing my hair, excellent eye contact, putting weight on her feet, beginning to roll over, has good head control- in other words, developmentally is exactly where she should be.
*She has grown 4 inches since birth, but she doesn't look scrawny. Long and lean, yes, but scrawny, no.
* She is very alert, self-awakes for all feeds now instead of me having to shove food down her like I did before because she just would not wake up and eat.

Bad points:
*Only 1/3 an ounce a day weight gain.
* She had never done above an half-ounce a day, but she's never plateaued, she is consistently growing.

She eats at least 10 minutes from both sides, often much longer. I think I've covered everything. I have a baby who wants to nurse Any advice?

Re: 3 1/2 month old slow growth, former EP- how serious is i

Not a super experienced mom here but all I read here was that your pedi is a BFing/nutrition idiot, you have LCs that appear to be on the same wavelength as a lot LLLs theory (which I agree with), your baby is on target with output/milestones/behavior, and your a great mom!

IMO cereal is stupid because cereals often can cause constipation (not something I'd want to deal with with a heart issue. JMO) IF you were going to add solids I would do avocado. But since she was a premie she might not be ready for solids till much later than term baby's 6months.

Things sound good to me; EBF... IMO.

Married to the best husband ever since Nov 2009
DS born 1/7/12 at 36 wks after PROM and Gestational diabetes happy and healthy ~

Re: 3 1/2 month old slow growth, former EP- how serious is i

I am scratching my head over this one.
When an infant is not gaining well then of course the advice is to nurse more often and for a longer duration.
Aim for 10-12 times a day.
In the event that your baby has suboptimal milk transfer..ie less than 2 ounces per feeding,( an IBCLC w/ a digital hospital scale weighs before and after a feeding)
You can supplement w/ expressed milk if need be.
There is no scientific rational behind adding rice cereal to an infants diet.
Rice is not the nutritionally correct food to help a baby gain weight.
The advice to add rice to your baby's bottle is a red flag.
I am also inclined to lean away from adding solids to your baby's diet at 4 months due to a lack of weight gain.
If your baby is not thriving, and I would not know this, i am not a doctor, then formula is the correct supplement to add.

Re: 3 1/2 month old slow growth, former EP- how serious is i

She gets about 2 ozs. a feeding on the LC scale, but since she eats 1 1/2 to 2 hours apart, and since she has a tendency to completely throw up the whole feeding if the volumes are too high, then they preferred that.

The thing is....she is thriving. Even the ped said she doesn't meet the FTT criteria because she's gaining steadily and is so good in just about every other area.

I would rather do solids then formula, in part because of the volumes issue. For 2-3 tbsp we can get her the calories that it would take her several extra bottles to get. She doesn't handle high volumes well...never has. One of the reasons I don't like his advice. Apparently that is common with preemies.

Re: 3 1/2 month old slow growth, former EP- how serious is i

I think I would ignore his advice I found with my own special needs baby that they have guidelines they want everyone to follow...and sometimes it just does not fit my baby. This might be such a case. If she is thriving otherwise, so she gains 1/3 of an oz a day.

If you have extra milk, take some of the extra, skim off the cream layer and put her meds into double cream bottles...extra calories and no solids she is not ready for yet.